AB0680 Psychological impact of autologous stem cell transplantation in systemic sclerosis patients and influence of support and coping strategies.
Authors: M. Schmalzing, N. Schwindl, L. Zerhusen, J. Henes, A. C. Pecher, H. P. Tony, M. Gernert, A. Kuebler, S. Kleih-Dahms, P. Ziebell, M. Fröhlich
Journal: Annals of the Rheumatic Diseases (2022)

Background In severe cases of systemic sclerosis (SSc), autologous hematopoietic stem cell transplantation (aHSCT) is superior compared to cyclophosphamide with respect to effect on skin and lung manifestations, survival and quality of life. Nevertheless, major physical and psychological impacts have been found in a first qualitative study by Spierings et al. (2020) 1 . Objectives Assessment of subjectively experienced physical and psychological impacts of aHSCT and exploration of potential interrelations of those impacts. Methods A SSc sample was assessed retrospectively after aHSCT in a two-step-approach. In the first step, 6 questionnaires were used: Global physical and mental health (SF-36 and Scleroderma Health Assessment Questionnaire = SHAQ), body image (Adapted Satisfaction with Appearance Scale = ASWAP), coping strategies (Freiburger Fragebogen zur Krankheitsverarbeitung = FKV-15), resilience (Resilienzskala = RS-11), and control beliefs (Fragebogen zur Erfassung von Kontrollüberzeugung zu Krankheit und Gesundheit = KKG). In the second step, semi-structured interviews based on Spierings et al. (2020) 1 were conducted and analysed via mixed methods qualitative content analysis following Mayring (2014). Results 19 patients (12 female, 7 male, mean age 53.47 years (SD = 9.50)) completed all questionnaires and interviews in a mean time of 6.56 years after aHSCT (SD = 3.90, range 1-12 years). A strong correlation was found between perceived physical impairment (SHAQ) and body image dissatisfaction (ASWAP) (Pearson’s r = .63, p &lt; .001). There was also a strong negative correlation between body image dissatisfaction (ASWAP) and the physical component of SF-36 (pcSF-36; r = -.59, p = .004) and a smaller correlation for the mental component of SF-36 (mcSF-36: r = -.38, p = .054). Depressive coping was negatively associated with SF-36 (pcSF-3: r = -.605, p = .003; mcSF-36: r = -.808, p &lt; .001) (see Figure 1), whereas resilience was associated with a positive impact (pcSF-36: r = .622, p = .002; mcSF-36 r = .595, p = .004). In the qualitative content analysis of the interviews, all patients reported symptom improvements (mainly skin), which were associated with their coping strategies (depressive coping with fewer improvements, active coping with more improvements). Describing their emotional state during aHSCT, 7 patients verbalized “despair”, 6 “loss of control”, 5 “emotional instability”, 4 ”distress due to distance from home”, 4 “loneliness”, 3 “listlessness”, 2 “concern for feelings of relatives”, and 2 “depersonalisation”. As valuable professional emotional support during aHSCT, 6 patients named nurses and 8 named physicians, while the crucial role of daily ward rounds of the specialised transplant team rather than the primary care team was emphasised. The additional support by a psychology team was not deemed necessary by 7 patients, while 4 patients would have wished such a support. 7 patients rated their physical and mental recovery after aHSCT as satisfying, 4 as better than expected, 4 as disappointing, and 3 as causing impatience. Figure 1. Correlation of SF-36 (physical and mental component) and FVK-15 (Depressive Coping Score) by Pearson’s Correlation Coefficient Conclusion A transient negative impact of aHSCT on mental wellbeing of the majority of SSc patients is evident, but can be relieved by professional teams highly specialised in this particular treatment option. References [1]Julia Spierings, et al. From “being at war” to “getting back on your feet”: A qualitative study on experiences of patients with systemic sclerosis treated with hematopoietic stem cell transplantation. Journal of Scleroderma and Related Disorders, vol. 5, 3: pp. 202-209. Disclosure of Interests None declared